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Changes After a Brain Injury

Changes in Attention and Concentration

Attention is being able to focus on what’s important and not get distracted by what isn’t important. The changes in attention that can happen after a brain injury can make it hard to follow a conversation, hard to work, or make it unsafe to cook a meal or drive.

Terms you may hear:

  • Alternating attention: This lets you to switch from one task to another without losing track of what you’re doing, and to keep track of several things at once.
  • Attentional capacity: This is how much information you can take in at once without getting overloaded. For example, the average adult can hear and repeat a 7-digit phone number but usually won’t remember it 5 minutes later.
  • Sustained attention: This is how long you can concentrate on an activity or task. It depends on the task, how tired you are, etc.
  • Selective attention: This is being able to ignore distractions. Examples of this may include having trouble with having a lot of visitors/people talking at the same time, or being easily distracted while driving. Other examples include forgetting what you were going to get from the bedroom, or trouble preparing a three-course meal.

In the early stages of recovery, the person may not be alert enough to communicate. He may not be fully aware of his environment. If he is able to maintain his attention, it may only be for a short amount of time. He may be restless.

At times, one small detail or focus on the wrong information may distract him. These distractions could be internal, as he might be distracted because he needs to go to the bathroom. Or the distraction could be external, for example, while talking with you, his attention may be on your tone of voice or your earlobe, rather than what you are saying. Or, he may be trying to pay attention to your words, how you look, noise from the street, and other activity in his room, all at the same time.

If he can’t concentrate, it’s hard to finish a task. He may know what he needs to do, but can have trouble keeping track of what he’s doing. We all have problems concentrating, especially when we’re tired or don’t feel well. For the person with a brain injury, it can be so hard to concentrate that he can’t do even the simplest task, like washing his hands or dressing.

Since it’s common to feel very tired (fatigued) after brain injury it can also be the reason why he seems to be so up and down during the day.

Tips to help with concentration and attention

  • Reduce distractions; have only one person in the room, turn off the TV or radio.
  • Break tasks into small steps.
  • Take away time pressures. Don’t rush through a task or expect it to be done perfectly.
  • Be sure you have his attention before starting a talk or task.
  • If his mind is wandering, use your voice to try to keep his attention. Show excitement in your voice and use gestures to bring his attention back to the task. If he seems to be withdrawing from you, try a quiet, soft-spoken approach.
  • Give new information in small bits and repeat it often. Have him repeat back the information to be sure he’s actually listening.
  • Encourage hobbies or activities that he enjoys and can do. Card games, puzzles, and reading help develop concentration.
  • Praise him when you see that he can pay attention longer (either listening or doing a task).
  • Make sure he doesn’t get too tired. People who have trouble focusing may get tired quickly. Make sure he takes short breaks to give his brain a rest.

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